Vertebroplasty feasible for at least 1 year after fracture

By Laura Cowen

Patients with subacute and chronic osteoporotic vertebral compression fractures (OVCF) can be successfully treated with percutaneous vertebroplasty between 2 and 12 months after symptom onset, say researchers.

Marc Nieuwenhuijse and colleagues from Leiden University Medical Center in the Netherlands explain that recent studies have questioned the value of vertebroplasty in OVCF.

They investigated the relationship between the time from fracture and the efficacy of vertebroplasty in 115 patients with 216 painful subacute (2-6 months old) or chronic (> 6 months old) OVCFs.

The patients were followed prospectively in the first postoperative year to assess the effect of vertebroplasty on pain relief and health-related quality of life (HRQoL).

As reported in the British edition of the Journal of Bone and Joint Surgery, the mean preoperative average back pain and severe (peak) back pain scores were 8.0 and 9.0, respectively, graded on a scale of 0-10 where 0 indicated no pain and 10 indicated unbearable pain.

At 1, 4, 12, and 52 weeks after vertebroplasty, the mean back pain scores were 5.1, 5.7, 4.6, and 4.3, respectively, and the severe back pain scores were 6.0, 6.5, 5.3, and 5.1, respectively. These data show that there was "an immediate and sustainable improvement in the level of back pain" after vertebroplasy, says the team.

HRQoL, assessed using the Short-Form 36 (SF-36) quality of life questionnaire, also improved immediately, with the physical component score increasing from 26.6 preoperatively to 31.9 at 4 weeks postoperatively. Furthermore, the effect was maintained at 12 and 52 weeks with respective scores of 33.1 and 33.5. Similar results were observed for the SF-36 mental component score.

Greater time from fracture was not associated with worse preoperative conditions, increased wedge angle or collapse of the vertebral body, or with the development of nonunion, as shown by the presence of an intravertebral cleft.

This is important because both increased vertebral body collapse and the presence of an intravertebral cleft have been associated with increased risk for complications, say the researchers.

The complication rate in the present study was low (2%) when cement leakage, which occurred in 72% of the treated OVCFs, was excluded.

"This study shows that it is feasible to delay vertebroplasty until a thorough patient evaluation is complete and possible alternative forms of treatment have been considered," Nieuwenhuijse and co-authors conclude.

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